Izinhlobo / ithambo / isiguli / ukwelashwa kwe-ewing-pdq

Ukwelashwa kwe-Ewing Sarcoma

Imininingwane ejwayelekile Mayelana ne-Ewing Sarcoma

AMAPHUZU ASEMQOKA

• I-Ewing sarcoma wuhlobo lwesimila olwenzeka ethanjeni noma kwizicubu ezithambile.

• I-cell sarcoma eyindilinga engahlukanisiwe nayo ingenzeka ithambo noma izicubu ezithambile.

• Izimpawu nezimpawu ze-Ewing sarcoma zifaka ukuvuvukala nobuhlungu eduze kwesimila.

• Izivivinyo ezihlola ithambo nezicubu ezithambile zisetshenziselwa ukuxilonga nokubeka isigaba i-Ewing sarcoma.

• I-biopsy yenziwa ukuxilonga i-Ewing sarcoma.

• Izici ezithile zithinta ukubikezela (ithuba lokululama).

I-Ewing sarcoma wuhlobo lwesimila olwenzeka ethanjeni noma kwizicubu ezithambile.

I-Ewing sarcoma uhlobo lwesimila esivela ohlotsheni oluthile lweseli ethanjeni noma ezicutshini ezithambile. Ukuthola i-sarcoma kungatholakala emathanjeni emilenze, izingalo, izinyawo, izandla, isifuba, ukhalo, umgogodla noma ugebhezi. I-Ewing sarcoma nayo ingatholwa kuzicubu ezithambile zesiqu, izingalo, imilenze, ikhanda, intamo, i-retroperitoneum (indawo engemuva kwesisu ngemuva kwezicubu ezibeka udonga lwesisu futhi zimboze iningi lezitho esiswini), noma ezinye izindawo.

Ukuthenga i-sarcoma kuvame kakhulu kwabasakhulayo nakwabadala (abasebasha kuya maphakathi no-20s).

I-Ewing sarcoma nayo ibizwa ngokuthi yi-peripheral primitive neuroectodermal tumor, isimila se-Askin (i-Ewing sarcoma yodonga lwesifuba), i-extraosseous Ewing sarcoma (i-Ewing sarcoma ngezicubu ngaphandle kwethambo), kanye ne-Ewing sarcoma family of tumors.

I-cell sarcoma eyindilinga engahlukanisiwe nayo ingenzeka ithambo noma izicubu ezithambile.

I-sarcoma eyindilinga engahlukanisiwe evame ukwenzeka emathanjeni noma emisipheni enamathiselwe emathanjeni futhi esiza umzimba ukuba unyakaze. Kunezinhlobo ezimbili ze-sarcoma eyindilinga engahlukanisiwe ephathwa njenge-Ewing sarcoma:

• I-sarcoma eyindilinga engafani nhlobo yokuhlelwa kabusha kwe-BCOR-CCNB3. Lolu hlobo lwesimila samathambo luvame ukwakheka okhalweni, ezingalweni, noma emilenzeni. Ingase isabalalele nakwezinye izingxenye zomzimba. Kulolu hlobo lwe-sarcoma eyindilinga, isakhi sofuzo se-BCOR sihlanganiswe nohlobo lweCCNB3. Ukuxilonga i-round cell sarcoma, amaseli wesimila ahlolwe lolu shintsho lwesakhi.

• I-sarcoma eyindilinga engafani nhlobo yokuhlelwa kabusha kwe-CIC-DUX4. Lolu hlobo lwesimila sezicubu ezithambile luvame ukwenzeka esiqwini, ezingalweni, noma emilenzeni. Kuvame kakhulu kwabesilisa nakwabantu abadala abaphakathi kweminyaka engama-21 nengama-40 ubudala. Kulolu hlobo lwe-sarcoma eyindilinga, isakhi sofuzo se-CIC sihlanganiswe nohlobo lwe-DUX4. Ukuxilonga i-round cell sarcoma, amaseli wesimila ahlolwe lolu shintsho lwesakhi.

Izimpawu nezimpawu ze-Ewing sarcoma zifaka ukuvuvukala nobuhlungu eduze kwesimila.

Lezi kanye nezinye izimpawu nezimpawu zingabangelwa i-Ewing sarcoma noma ezinye izimo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

• Ubuhlungu kanye / noma ukuvuvukala, imvamisa kusezingalweni, emilenzeni, esifubeni, emuva, noma okhalo.

• Isigaxa (esingazizwa sithambile futhi sifudumele) ezandleni, emilenzeni, esifubeni noma okhalweni.

• Umkhuhlane ngaphandle kwesizathu esaziwayo.

• Ithambo eliphuka ngaphandle kwesizathu esaziwayo.

Izivivinyo ezihlola ithambo nezicubu ezithambile zisetshenziselwa ukuxilonga nokubeka isigaba i-Ewing sarcoma.

Izinqubo ezenza izithombe zamathambo nezicubu ezithambile nezindawo eziseduze zisiza ukuxilonga i-Ewing sarcoma futhi zikhombise ukuthi umdlavuza ususabalale kangakanani. Inqubo esetshenziselwe ukuthola ukuthi ngabe amangqamuzana omdlavuza asabalale ngaphakathi nangaphakathi kwamathambo nezicubu ezithambile noma kwezinye izingxenye zomzimba ibizwa ngokuthi yi-staging.

Ukuhlela ukwelashwa, kubalulekile ukwazi ukuthi umdlavuza ususabalele nakwezinye izingxenye zomzimba. Ukuhlolwa nezinqubo zokuthola, ukuxilonga, kanye nesigaba se-Ewing sarcoma kuvame ukwenziwa ngasikhathi sinye.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziselwa ukuxilonga noma ukulinganisa i-Ewing sarcoma:

• Ukuhlolwa komzimba kanye nomlando: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.

• I-MRI (imaging resonance imaging): Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi komzimba, ezifana nendawo lapho kwakhiwa khona isimila. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

I-Magnetic resonance imaging (MRI) yesisu. Ingane ilele etafuleni elingena kuskena seMRI, esithwebula izithombe zangaphakathi komzimba. Iphedi esiswini sengane isiza ukwenza izithombe zicace bha.

• I-CT scan (i-CAT scan): Inqubo eyenza uchungechunge lwezithombe eziningiliziwe zezindawo ezingaphakathi komzimba, njengendawo lapho kwakhiwa khona isimila noma isifuba, ezithathwe ezinhlangothini ezahlukene. Izithombe zenziwa yikhompyutha exhunywe kumshini we-x-ray. Idayi ingajovwa emthanjeni noma igwinywe ukusiza izitho noma izicubu zivele kahle. Le nqubo ibizwa nangokuthi i-computed tomography, i-computerized tomography, noma i-computer axial tomography.

Iskena se-computed tomography (CT) sesisu. Ingane ilele etafuleni elishibilika ngesithwebuli se-CT, esithatha izithombe ze-x-ray zangaphakathi kwesisu.

• I-PET scan (i-positron emission tomography scan): Inqubo yokuthola amangqamuzana abulalayo omzimba emzimbeni. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni. Isithwebuli se-PET sizungeza umzimba futhi senze isithombe lapho i-glucose isetshenziswa khona emzimbeni. Amaseli amathumba amabi abonakala ekhanya esithombeni ngoba ayasebenza futhi athatha i-glucose eningi kunamaseli avamile. I-PET scan ne-CT scan kuvame ukwenziwa ngasikhathi sinye. Uma kukhona umdlavuza, lokhu kwandisa amathuba okuthi utholakale.

Ukuskena kwePositron emission tomography (PET). Ingane ilele phezu kwetafula elishibilika ngesithwebuli se-PET. Ukuphumula kwekhanda nomucu omhlophe kusiza ingane ukuba ilele inganyakazi. Inani elincane le-glucose enemisebe (ushukela) lifakwa emthanjeni wengane, futhi isithwebuli senza isithombe sokuthi i-glucose isetshenziswa kuphi emzimbeni. Amaseli womdlavuza avela ngokugqamile esithombeni ngoba athatha i-glucose eningi kunamaseli avamile.

• Ukuskena kwamathambo: Inqubo yokubheka ukuthi kunamaseli ahlukanisa ngokushesha yini, njengamaseli womdlavuza, ethanjeni. Inani elincane kakhulu lezinto ezinomsakazo lifakwa emthanjeni futhi lihambe phakathi kwegazi. Izinto ezinemisebe eqoqa emathanjeni ezinomdlavuza futhi zitholwa isithwebuli.

Ukuskena kwamathambo. Inani elincane lezinto ezikhipha imisebe lifakwa emthanjeni wengane futhi lihamba egazini. Izinto ezinemisebe eqoqa emathanjeni. Ngenkathi ingane ilele etafuleni elishibilika ngaphansi kwesithwebuli, kutholwa okokusebenza okukhipha imisebe bese kwenziwa izithombe esikrinini sekhompyutha.

• Isifiso somnkantsha we-Bone kanye ne-biopsy: Ukususwa komnkantsha kanye nocezu oluncane lwethambo ngokufaka inaliti engenalutho emvubeni. Amasampula asuswa kuwo womabili amathambo. Isazi sezifo sibheka umnkantsha nethambo ngaphansi kwesibonakhulu ukubona ukuthi umdlavuza ususakazekile yini.

Ukufiswa komnkantsha we-Bone kanye ne-biopsy. Ngemuva kokuthi indawo encane yesikhumba iboshwe, kufakwa inaliti yomnkantsha ethanjeni lesinqe sengane. Amasampula egazi, amathambo, nomnkantsha uyasuswa ukuze kuhlolwe ngaphansi kwesibonakhulu.

• I-X-ray: I-x-ray uhlobo lwesigongolo samandla esingadlula emzimbeni bese singena kwifilimu, senze isithombe sezindawo ezingaphakathi komzimba, njengesifuba noma indawo lapho kwakhiwa khona isimila.

• Qedela ukubalwa kwegazi (i-CBC): Inqubo lapho kukhishwa khona isampula legazi futhi lihlolwe lokhu okulandelayo:

• Inani lamaseli abomvu egazi, amaseli amhlophe egazi, nama-platelets.

• Inani le-hemoglobin (iprotheni ethwala umoya-mpilo) kumaseli abomvu egazi.

• Ingxenye yesampula yegazi eyenziwe ngamaseli abomvu egazi.

• Izifundo ze-chemistry yegazi: Inqubo lapho kuhlolwe khona isampula segazi ukukala inani lezinto ezithile, njenge-lactate dehydrogenase (LDH), ekhishelwa egazini ngezitho nezicubu zomzimba. Inani elingavamile (eliphakeme noma eliphansi kunokujwayelekile) lezinto kungaba uphawu lwesifo.

I-biopsy yenziwa ukuxilonga i-Ewing sarcoma.

Amasampula amathishu ayasuswa ngesikhathi sokuhlolwa komzimba ukuze abukwe ngaphansi kwesibonakhulu ngudokotela wezifo ukuze ahlole izimpawu zomdlavuza. Kuyasiza uma i-biopsy yenziwa esikhungweni esisodwa lapho kuzonikezwa khona ukwelashwa.

• I-Needle biopsy: Nge-biopsy yenaliti, izicubu zisuswa kusetshenziswa inaliti. Lolu hlobo lwe-biopsy lungenziwa uma kungenzeka ukuthi kususwe amasampula wezicubu ezinkulu ngokwanele ukuthi angasetshenziselwa ukuhlolwa.

• I -incisional biopsy: Ukuze kwenziwe i-incisional biopsy, isampula lezicubu liyasuswa ngokusikwa esikhumbeni.

• I-Biopsy e-Excisional: Ukususwa kwesigaxa sonke noma indawo yezicubu ezingabonakali zijwayelekile.

Ochwepheshe (i-pathologist, i-radiation oncologist, nodokotela ohlinzayo) abazokwelapha isiguli bavame ukusebenza ndawonye ukunquma indawo engcono kakhulu yokubeka inaliti noma i-biopsy incision. Ukukhethwa kwesiza se-biopsy kubalulekile. Isayithi le-biopsy elingakhethwanga kahle lingaholela ekuhlinzweni okukhulu ukukhipha isimila noma indawo enkudlwana ephathwa ngemithi yokwelashwa ngemisebe.

Uma kunethuba lokuthi umdlavuza usabalalele kuma-lymph node aseduze, i-lymph node eyodwa noma ngaphezulu ingasuswa futhi ihlolwe izimpawu zomdlavuza.

Ukuhlolwa okulandelayo kungenziwa kuzicubu ezisuswe:

• Ukuhlaziywa kwe-cytogenetic: Ukuhlolwa kwelabhoratri lapho ama-chromosomes amaseli esampula yezicubu abalwa khona futhi ahlolwe noma yiziphi izinguquko, ezinjengama-chromosomes aphukile, alahlekile, ahlelwe kabusha, noma amanye. Izinguquko kuma-chromosomes athile kungaba luphawu lomdlavuza. Ukuhlaziywa kwe-cytogenetic kusetshenziselwa ukuxilonga umdlavuza, ukuhlela ukwelashwa, noma ukuthola ukuthi ukwelashwa kusebenza kahle kangakanani.

• I-Immunohistochemistry: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukubheka ama-antigen athile (omaka) kusampula lezicubu zesiguli. Amasosha omzimba avamise ukuhlanganiswa ne-enzyme noma udayi we-fluorescent. Ngemuva kokuthi ama-antibody abophe i-antigen ethile kusampula yezicubu, i-enzyme noma idayi iyasebenza, bese i-antigen bese ibonwa ngaphansi kwesibonakhulu. Lolu hlobo lokuhlola lusetshenziselwa ukuxilonga umdlavuza nokusiza ukutshela uhlobo oluthile lomdlavuza kolunye uhlobo lomdlavuza.

• Flow cytometry: Isivivinyo selabhorethri esikala inani lamaseli esampula, iphesenti lamaseli abukhoma kusampula, kanye nezici ezithile zamaseli, njengosayizi, umumo, nokuba khona komaka be-tumor (noma okunye) ubuso beseli. Amaseli avela kusampula yegazi lesiguli, umnkantsha, noma ezinye izicubu anamabala ombala we-fluorescent, afakwa kuketshezi, abese edluliswa ngalinye ngesikhathi emgqeni wokukhanya. Imiphumela yokuhlolwa isuselwa ekutheni amangqamuzana abenebala lodayi we-fluorescent asabela kanjani oshalweni lokukhanya.

Izici ezithile zithinta ukubikezela (ithuba lokululama).

Izici ezithinta ukubikezela (ithuba lokululama) zihlukile ngaphambi nangemva kokwelashwa.

Ngaphambi kokuba kunikezwe noma iyiphi indlela yokwelashwa, ukubikezela kuya ngokuthi:

• Ukuthi isimila sesisabalalele kuma-lymph node noma ezingxenyeni ezikude zomzimba.

• Lapho emzimbeni kuqale isimila.

• Ukuthi isimila sakhiwe yini ethanjeni noma ezicutshini ezithambile.

• Sikhulu kangakanani isimila lapho kutholakala isimila.

• Ukuthi isimila sibangele noma yimaphi amathambo aphukile.

• Ukuthi izinga le-LDH egazini liphakeme kunokujwayelekile.

• Ukuthi isimila sinezinguquko ezithile zofuzo yini.

• Ukuthi isiguli singaphansi kweminyaka engu-15 yini.

• Ubulili besiguli.

• Ukuthi isiguli sithole ukwelashwa komdlavuza ohlukile.

• Ukuthi isimila sisanda kutholakala yini noma sesiphindile (buyela emuva).

Ngemuva kokunikezwa ukwelashwa, ukubikezela kuthinteka yi:

• Ukuthi isimila sisuswe ngokuphelele yini ngokuhlinzwa.

• Ukuthi isimila siphendule yini ekwelashweni ngamakhemikhali noma ekwelashweni ngemisebe.

Uma umdlavuza ubuyela emuva ngemuva kokwelashwa kokuqala, ukubikezela kuncike ku:

• Ukuthi umdlavuza ubuyile ngaphezulu kweminyaka emibili ukwelashwa kokuqala.

• Ukuthi umdlavuza ubuyile lapho uqale wakha khona noma kwezinye izingxenye zomzimba.

Izigaba ze-Ewing Sarcoma

AMAPHUZU ASEMQOKA

• Imiphumela yokuhlola ukuxilongwa kanye nesiteji isetshenziselwa ukuthola ukuthi ngabe amaseli womdlavuza asakazekile yini.

• I-Ewing sarcoma ichazwa njengeyendawo, imastastatic, noma ephindaphindwayo.

• I-Ewing sarcoma yasendaweni

• I-Metastatic Ewing sarcoma

• I-Ewing sarcoma ejwayelekile

• Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

• Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Imiphumela yokuhlola ukuxilongwa kanye nesiteji isetshenziselwa ukuthola ukuthi ngabe amaseli womdlavuza asakazekile yini.

Inqubo esetshenzisiwe ukuthola ukuthi umdlavuza ususabalalisile yini ukusuka lapho uqale khona kwezinye izingxenye zomzimba ibizwa nge-staging. Alukho uhlelo olujwayelekile lwe-Ewing sarcoma. Imiphumela yezivivinyo nezinqubo ezenziwe ukuxilonga kanye nesiteji i-Ewing sarcoma isetshenziselwa ukuchaza izicubu njengezenziwe endaweni noma nge-metastatic.

I-Ewing sarcoma ichazwa njengeyendawo, imastastatic, noma ephindaphindwayo.

I-Ewing sarcoma ichazwa njengeyendawo, i-metastatic, noma ephindaphindwayo.

I-Ewing sarcoma yasendaweni

Umdlavuza utholakala ethanjeni noma esikhunjeni esithambile lapho uqale khona futhi kungenzeka ukuthi usabalalele ezicutshini eziseduze, kufaka phakathi ama-lymph node aseduze.

I-Metastatic Ewing sarcoma

Umdlavuza usabalale ethanjeni noma ezicutshini ezithambile lapho uqale khona kwezinye izitho zomzimba. Ku-Ewing tumor of bone, umdlavuza uvame ukusabalala uye emaphashini, kwamanye amathambo, nasemnkantsheni.

I-Ewing sarcoma ejwayelekile

Umdlavuza ubuye wabuya (ubuya) ngemuva kokuba welashwe. Umdlavuza ungabuya ithambo noma izicubu ezithambile lapho uqale khona noma kwenye ingxenye yomzimba.

Zintathu izindlela umdlavuza osakazeka ngayo emzimbeni.

Umdlavuza ungasakazeka ngezicubu, uhlelo lwe-lymph, kanye negazi:

• Izicubu. Umdlavuza usakazeka lapho uqale khona ngokukhulela ezindaweni eziseduze.

• Uhlelo lweLymph. Umdlavuza usakazeka lapho uqale khona ngokungena ohlelweni lwe-lymph. Umdlavuza udabula imithambo ye-lymph uye kwezinye izingxenye zomzimba.

• Igazi. Umdlavuza usakazeka lapho uqale khona ngokungena egazini. Umdlavuza uhamba ngemithambo yegazi uye kwezinye izingxenye zomzimba.

Umdlavuza ungasakazeka usuka lapho uqale khona kwezinye izingxenye zomzimba.

Lapho umdlavuza usakazekela kolunye uhlangothi lomzimba, ubizwa ngokuthi yi-metastasis. Amaseli womdlavuza aqhamuka lapho aqale khona (isimila sokuqala) futhi ahamba ngohlelo lwe-lymph noma igazi.

• Uhlelo lweLymph. Umdlavuza ungena ohlelweni lwe-lymph, udabule emithanjeni ye-lymph, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

• Igazi. Umdlavuza ungena egazini, udabule emithanjeni yegazi, bese wenza isimila (isimila se-metastatic) kwenye ingxenye yomzimba.

Isigaxa se-metastatic luhlobo olufanayo lomdlavuza njengesimila sokuqala. Isibonelo, uma i-Ewing sarcoma isakazekela emaphashini, amangqamuzana omdlavuza asephashini empeleni angama-Ewing sarcoma cells. Lesi sifo yi-metastatic Ewing sarcoma, hhayi umdlavuza wamaphaphu.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukene zokwelashwa ezinganeni ezine-Ewing sarcoma.

• Izingane ezine-Ewing sarcoma kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni umdlavuza ezinganeni.

• Ukwelashwa kwe-Ewing sarcoma kungadala imiphumela emibi.

• Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

• Ukwelashwa ngamakhemikhali

• Ukwelashwa ngemisebe

• Ukuhlinzwa

• I-chemotherapy ephezulu ene-stem cell Rescue

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa okuhlosiwe

• I-Immunotherapy

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

• Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukene zokwelashwa ezinganeni ezine-Ewing sarcoma.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezinganeni ezine-Ewing sarcoma. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile.

Ngoba umdlavuza ezinganeni nasebusheni uyivelakancane, ukubamba iqhaza esivivinyweni somtholampilo kufanele kubhekwe. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izingane ezine-Ewing sarcoma kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni umdlavuza ezinganeni.

Ukwelashwa kuzobhekwa ngudokotela wezingane oncologist, udokotela ogxile ekwelapheni izingane ezinomdlavuza. I-oncologist yezingane isebenza nabanye abahlinzeki bokunakekelwa kwempilo abangochwepheshe ekwelapheni izingane ezine-Ewing sarcoma futhi abagxile ezindaweni ezithile zemithi. Lokhu kungafaka ongoti abalandelayo:

• Udokotela wezingane.

• I-oncologist yokuhlinza noma i-orcopedic oncologist.

• I-radiation oncologist.

• Umhlengikazi ongumhlengikazi.

• Usonhlala kahle.

• Uchwepheshe wokuvuselelwa.

• Isazi sokusebenza kwengqondo.

Ukwelashwa kwe-Ewing sarcoma kungadala imiphumela emibi.

Ngemininingwane ngemiphumela emibi eqala ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Imiphumela emibi yokwelashwa komdlavuza eqala ngemuva kokwelashwa futhi iqhubeke izinyanga noma iminyaka ibizwa ngemiphumela ephuzile. Imiphumela yamuva yokwelashwa komdlavuza ingafaka okulandelayo:

• Izinkinga zomzimba.

• Izinguquko zemizwa, imizwa, ukucabanga, ukufunda, noma inkumbulo.

• Umdlavuza wesibili (izinhlobo ezintsha zomdlavuza). Iziguli ezelashelwa i-Ewing sarcoma zisengozini enkulu yokuthola i-acute myeloid leukemia kanye ne-myelodysplastic syndrome. Kukhona nobungozi obandayo be-sarcoma endaweni ephathwa ngemithi yokwelashwa ngemisebe.

Eminye imiphumela yesikhashana ingalashwa noma ilawulwe. Kubalulekile ukukhuluma nodokotela bengane yakho ngemiphumela yokwelashwa komdlavuza engaba nayo enganeni yakho. (Bheka isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane.)

Izinhlobo ezine zokwelashwa ezijwayelekile zisetshenzisiwe:

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda). Inhlanganisela yamakhemikhali ukwelashwa kusetshenziswa izidakamizwa ezingaphezu kwesisodwa ze-anticancer.

I-systemic combination chemotherapy iyingxenye yokwelashwa kwazo zonke iziguli ezinezicubu ze-Ewing. Imvamisa kuyindlela yokuqala yokwelashwa enikezwayo futhi ihlala cishe izinyanga eziyi-6 kuye kwezingu-12. I-Chemotherapy ivame ukunikezwa ukunciphisa isimila ngaphambi kokuhlinzwa noma ukwelashwa ngemisebe nokubulala noma yimaphi amaseli wesimila okungenzeka asakazekele kwezinye izingxenye zomzimba.

Bheka Izidakamizwa Ezivunyelwe I-Soft Tissue Sarcoma ukuthola eminye imininingwane.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Kunezinhlobo ezimbili zokwelashwa ngemisebe:

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.

Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha i-Ewing sarcoma.

Ukwelashwa ngemisebe kusetshenziswa lapho isimila singeke sisuswe ngokuhlinzwa noma lapho ukuhlinzwa kususa isimila kuzothinta imisebenzi ebalulekile yomzimba noma indlela ingane ezobukeka ngayo. Ingasetshenziselwa ukwenza isimila sibe sincane futhi sinciphise inani lezicubu ezidinga ukususwa ngesikhathi sokuhlinzwa. Ingasetshenziselwa ukwelapha noma isiphi isimila esisele ngemuva kokuhlinzwa nezicubu ezisabalalele kwezinye izingxenye zomzimba.

Ukuhlinzwa

Ukuhlinzwa kuvame ukwenziwa ukususa umdlavuza osele ngemuva kwe-chemotherapy noma i-radiation therapy. Uma kungenzeka, sonke isimila sisuswa ngokuhlinzwa. Izicubu namathambo okususiwe kungashintshwa kufakwe okuxhunywayo, okusebenzisa izicubu namathambo athathwe kwenye ingxenye yomzimba wesiguli noma lowo onikelayo. Kwesinye isikhathi kusetshenziswa okufakelwa, njengethambo lokufakelwa.

Ngemuva kokuthi udokotela awususe wonke umdlavuza ongabonakala ngesikhathi sokuhlinzwa, ezinye iziguli zinganikezwa i-chemotherapy noma i-radiation therapy ngemuva kokuhlinzwa ukubulala noma yimaphi amangqamuzana omdlavuza asele. Ukwelashwa okunikezwe ngemuva kokuhlinzwa, ukwehlisa ubungozi bokuthi umdlavuza uzobuya, kubizwa ngokuthi yi-adjuvant therapy.

I-chemotherapy ephezulu ene-stem cell Rescue

Imithamo ephezulu yokwelashwa ngamakhemikhali inikezwa ukubulala amangqamuzana omdlavuza. Amaseli aphilile, kufaka phakathi amaseli akha igazi, nawo abhujiswa ukwelashwa komdlavuza. Ukufakelwa kwe-stem cell ukwelashwa ukufaka amaseli akha igazi. Ama-stem cells (amangqamuzana egazi angavuthiwe) ayasuswa egazini noma emnkantsheni wethambo wesiguli noma womnikeli futhi afriziwe futhi agcinwe. Ngemuva kokuthi isiguli siqede i-chemotherapy, amangqamuzana eziqu agciniwe ancibilika abuyiselwa esigulini ngokumnika. Lawa maseli wesiqu abuyisiwe akhula abe (futhi abuyisele) amangqamuzana egazi omzimba. I-Chemotherapy nge-stem cell Rescue isetshenziselwa ukwelapha i-Ewing sarcoma yasendaweni nephindayo.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Lesi sigaba esifingqiwe sichaza izindlela zokwelashwa ezicwaningwa ekuhlolweni kwemitholampilo. Kungenzeka kungasho yonke imishanguzo emisha efundwayo. Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe ukwelashwa okusebenzisa izidakamizwa noma ezinye izinto ukuphazamisa izinqubo ezidinga ukukhula namaseli omdlavuza. Izinhlobo zezindlela zokwelashwa eziqondisiwe ezisetshenziselwa ukwelapha umdlavuza wezingane ongajwayelekile zifaka okulandelayo:

• Ukwelashwa kwe-monoclonal antibody: Ama-antibody e-monoclonal enziwa elebhu kusuka ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile ezingasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba anamathela ezintweni futhi abulale amangqamuzana omdlavuza, avimbe ukukhula kwawo, noma awagcine ekusakazekeni. Ama-antibody e-monoclonal anikezwa ngokumnika. Zingasetshenziswa zodwa noma ukuphatha izidakamizwa, ubuthi, noma okokukhipha imisebe ngqo emangqamuzaneni omdlavuza. IGanitumab isafundelwa ukwelashwa kwe-metastatic Ewing sarcoma.

• Ukwelashwa kwe-Kinase inhibitor: I- Kinase inhibitors yizidakamizwa ezivimba iphrotheni edingekayo ukuze amangqamuzana omdlavuza ahlukane. Bafundelwa ukwelapha i-Ewing sarcoma ephindaphindwayo.

• Ukwelashwa kwe-NEDD8-activating enzyme (NAE) inhibitor therapy: I- NAE inhibitors yimithi enamathela ku-NAE futhi emisa amangqamuzana omdlavuza ekuhlukaniseni. I-Pevonedistat ifundelwa ekwelapheni i-Ewing sarcoma ephindaphindwayo.

I-Immunotherapy

I-Immunotherapy yimithi esebenzisa amasosha omzimba esiguli ukulwa nomdlavuza. Izinto ezenziwe ngumzimba noma ezenziwe elabhoratri zisetshenziselwa ukukhulisa, ukuqondisa, noma ukubuyisa izivikelo zemvelo zomzimba kumdlavuza. Lolu hlobo lokwelashwa komdlavuza lubizwa nangokuthi i-biotherapy noma i-biologic therapy.

• Ukwelashwa kwe-immune checkpoint inhibitor Therapy: Amasosha omzimba okuhlola izivikeli mzimba avimba amaprotheni athile enziwa amaseli omzimba, njengama-T cell, namanye amangqamuzana omdlavuza. Lawa maprotheni asiza ukugcina izimpendulo zokuzivikela ezifweni futhi angagcina amaseli e-T ekubulaleni amangqamuzana omdlavuza. Lapho lawa maprotheni evinjiwe, "amabhuleki" amasosha omzimba ayadedelwa futhi ama-T cell akwazi ukubulala amangqamuzana omdlavuza kangcono. I-Nivolumab ne-ipilimumab yizinhlobo zama-immune checkpoint inhibitors afundelwa ukwelapha i-Ewing sarcoma ephindaphindwayo.

• Ukwelashwa kwe- T-cell kwe- Chimeric antigen receptor (CAR): Ukwelashwa kwe- CAR T-cell uhlobo lwe-immunotherapy olushintsha amaseli we-T wesiguli (uhlobo lweseli lomzimba) ukuze ahlasele amaprotheni athile ebusweni bamangqamuzana omdlavuza. Amaseli we-T athathwa esigulini futhi ama-receptors akhethekile afakwa ebusweni bawo elabhoratri. Amaseli aguqukile abizwa ngamaseli we-chimeric antigen receptor (CAR) T. Amaseli e-CAR T akhuliswa elabhorethri futhi anikezwa isiguli ngokufakwa. Amaseli e-CAR T ayanda egazini lesiguli bese ehlasela amangqamuzana omdlavuza. Ukwelashwa kwe-CAR T-cell kuyacutshungulwa ekwelapheni i-Ewing sarcoma ephindaphindwayo.

Ukwelashwa kwe-CAR T-cell. Uhlobo lokwelashwa lapho kuguqulwa khona ama-T cell wesiguli (uhlobo lwamaseli omzimba) elabhoratri ngakho-ke azobopha amaseli womdlavuza futhi awabulale. Igazi elivela emthanjeni engalweni yesiguli ligeleza ngeshubhu liye emshinini we-apheresis (ongakhonjisiwe), osusa amangqamuzana amhlophe egazi, kufaka phakathi ama-T cell, bese lithumela lonke igazi emuva esigulini. Ngemuva kwalokho, kufakwa isakhi sofuzo se-receptor ekhethekile ebizwa nge-chimeric antigen receptor (CAR) kumaseli we-T elabhorethri. Izigidi zamaseli e-CAR T zikhuliswa elabhoratri bese zinikezwa isiguli ngokumnika. Amaseli e-CAR T akwazi ukubopha i-antigen kumaseli womdlavuza futhi awabulale.

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. Ukuhlolwa kwemitholampilo kuyingxenye yenqubo yocwaningo lomdlavuza. Ukuhlolwa komtholampilo kuyenziwa ukuthola ukuthi ngabe ukwelashwa komdlavuza okusha kuphephile futhi kuyasebenza yini noma kungcono kunokwelashwa okujwayelekile.

Eziningi zezindlela zokwelashwa ezijwayelekile zomdlavuza zisuselwa ekuhlolweni kokuqala komtholampilo. Iziguli ezibamba iqhaza esivivinyweni somtholampilo zingathola ukwelashwa okujwayelekile noma zibe phakathi kwabokuqala ukuthola ukwelashwa okusha.

Iziguli ezibamba iqhaza ezivivinyweni zokwelashwa zisiza nokwenza ngcono indlela umdlavuza ozophathwa ngayo ngokuzayo. Noma izilingo zomtholampilo zingaholeli ekwelashweni okusha okusebenzayo, zivame ukuphendula imibuzo ebalulekile futhi zisize ukuqhubela phambili ucwaningo.

Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

Ezinye izivivinyo zokwelashwa zifaka kuphela iziguli ezingakatholi ukwelashwa. Ezinye izilingo zivivinya ukwelashwa kweziguli ezinomdlavuza ongakabi ngcono. Kukhona nokuhlolwa komtholampilo okuhlola izindlela ezintsha zokunqanda umdlavuza ukuthi ungaphindi (ubuye) noma kunciphise imiphumela emibi yokwelashwa komdlavuza.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo esekelwa yi-NCI ingatholakala ekhasini lewebhu le-NCI lokuhlolwa kokuhlolwa kwemitholampilo. Izivivinyo zomtholampilo ezisekelwa ezinye izinhlangano zingatholakala kuwebhusayithi yeClinicalTrials.gov.

Ukuhlolwa kokulandelela kungadingeka.

Olunye uvivinyo olwenziwe ukuxilonga umdlavuza noma ukuthola isigaba somdlavuza lungaphindwa. Olunye uvivinyo luzophindwa ukuze kubonakale ukuthi umuthi usebenza kanjani. Izinqumo mayelana nokuthi uqhubeke, ushintshe, noma umise ukwelashwa zingasuselwa emiphumeleni yalezi zivivinyo.

Ezinye zezivivinyo zizoqhubeka ukwenziwa ngezikhathi ezithile ngemuva kokuphela kokwelashwa. Imiphumela yalezi zivivinyo ingakhombisa ukuthi ngabe isimo sengane yakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Izinketho Zokwelapha ze-Ewing Sarcoma

Kulesi Sigaba

• I-Ewing Sarcoma Yasendaweni

• I-Metastatic Ewing Sarcoma

• Ukuphindaphinda i-Ewing Sarcoma

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

I-Ewing Sarcoma Yasendaweni

Ukwelashwa okujwayelekile kwe-Ewing sarcoma okwenziwe endaweni kufaka:

• Ukwelashwa ngamakhemikhali.

• Ukuhlinzwa kanye / noma ukwelashwa ngemisebe.

• I-chemotherapy ephezulu ene-stem cell Rescue.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

I-Metastatic Ewing Sarcoma

Ukwelashwa okujwayelekile kwe-metwingatic Ewing sarcoma kufaka:

• Ukwelashwa ngamakhemikhali.

• Ukuhlinzwa.

• Ukwelashwa ngemisebe.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Ukuphindaphinda i-Ewing Sarcoma

Akukho ukwelashwa okujwayelekile kwe-Ewing sarcoma ephindaphindwayo kepha izinketho zokwelashwa zingafaka okulandelayo:

• Inhlanganisela chemotherapy.

• Ukwelashwa ngemisebe kwizicubu zethambo, njengokwelashwa okunciphisayo ukukhulula izimpawu nokuthuthukisa ikhwalithi yempilo.

• Ukwelashwa ngemisebe okungase kulandelwe ukuhlinzwa ukuze kususwe izicubu ezisabalalele emaphashini.

• I-chemotherapy ephezulu ene-stem cell Rescue.

Izinketho zokwelashwa ezifundelwa i-Ewing sarcoma ephindaphindwayo zifaka okulandelayo:

• Ukuhlola isampula lesimila sesiguli ngezinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

• Ukwelashwa okuqondisiwe nge-tyrosine kinase inhibitor (cabozantinib).

• I-Immunotherapy ene-immune checkpoint inhibitor (nivolumab noma ipilimumab).

• Ukwelashwa kwe-T-cell kwe-Chimeric antigen receptor (CAR).

• Ukwelashwa okuhlosiwe nge-NEDD8-activating enzyme inhibitor (pevonedistat) kanye ne-chemotherapy.

• Isivivinyo somtholampilo sohlobo olusha lwezokwelapha ezihlosiwe.

Sebenzisa ukusesha kwethu kokuhlolwa komtholampilo ukuthola izivivinyo zomtholampilo ezisekelwa yi-NCI ezamukela iziguli. Ungasesha izivivinyo ngokususelwa ohlotsheni lomdlavuza, iminyaka yesiguli, nalapho kwenziwa khona izivivinyo. Imininingwane ejwayelekile mayelana nokuhlolwa kwemitholampilo iyatholakala.

Ukufunda Kabanzi Nge-Ewing Sarcoma

Ngeminye imininingwane evela ku-National Cancer Institute mayelana ne-Ewing sarcoma, bheka okulandelayo:

• Ikhasi Lasekhaya Lomdlavuza Wamathambo

• I-Computed Tomography (CT) Iskena Nomdlavuza

• Izindlela Zokwelapha Zomdlavuza

• Umdlavuza Wamathambo

Ngemininingwane eminingi yomdlavuza wezingane nezinye izinsiza zomdlavuza ezijwayelekile, bheka okulandelayo:

• Mayelana Nomdlavuza

• Umdlavuza Wezingane

• I-CureSearch ye-Cancer YezinganePhuma Ukuzikhulula

• Imiphumela Emuva Yokwelapha Yomdlavuza Wezingane

• Intsha kanye nabantu abadala abancane abaneCancer

• Izingane Ezinomdlavuza: Umhlahlandlela Wabazali

• Umdlavuza Ezinganeni Nasebusheni

• Isiteji

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli